Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Mar 18, 2015; 6(2): 278-283
Published online Mar 18, 2015. doi: 10.5312/wjo.v6.i2.278
Is non-biological treatment of rheumatoid arthritis as good as biologics?
Jyoti Ranjan Parida, Durga Prasanna Misra, Anupam Wakhlu, Vikas Agarwal
Jyoti Ranjan Parida, Durga Prasanna Misra, Vikas Agarwal, Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
Anupam Wakhlu, Department of Rheumatology, King George’s Medical University, Lucknow 226014, India
Author contributions: All the authors have contributed equally in collecting references, conceptualizing and interpreting data, designing manuscript, writing manuscript including revision and final approval.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Vikas Agarwal, Additional Professor, Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, India.
Telephone: +91-52-22494318 Fax: +91-52-22668812
Received: February 12, 2014
Peer-review started: February 13, 2014
First decision: March 26, 2014
Revised: April 10, 2014
Accepted: September 6, 2014
Article in press: September 10, 2014
Published online: March 18, 2015

The management of rheumatoid arthritis (RA) in the past three decades has undergone a paradigm shift from symptomatic relief to a “treat-to-target” approach. This has been possible through use of various conventional and biologic disease modifying anti-rheumatic drugs (DMARDs) which target disease pathogenesis at a molecular level. Cost and infection risk preclude regular use of biologics in resource-constrained settings. In the recent years, evidence has emerged that combination therapy with conventional DMARDs is not inferior to biologics in the management of RA and is a feasible cost-effective option.

Keywords: Rheumatoid arthritis, Disease modifying drugs, Biologics, Methotrexate, Sulfasalazine, Leflunomide, Cyclosporine, Hydroxychloroquine, Tumor necrosis factor, Remission, Radiologic outcome

Core tip: In developing world cost of treatment remains a major concern. Recent evidences are emerging that support the equal efficacy of conventional disease modifying anti-rheumatic drugs (DMARDs) as compared to biological DMARDs. In this review we have presented evidences supporting conventional DMARDs in management of rheumatoid arthritis.